Form LIC 9264 is used in California by care facilities to calculate and report the annual provider fee owed to the California Department of Social Services. This form is completed on an annual basis by the facility operator or administrator.
Form LIC 9263 is used in California by care facilities to report and track the resident population within their facility. This form is completed on an annual basis by the facility operator or administrator.
Form LIC 9242 is used in California by residential care facilities for the elderly (RCFE) to document and track the process of admitting an elderly individual into their facility. This form is completed by RCFE personnel when accepting residents for care and support.
Form LIC 9241 is used in California by adult care facilities to document and track the process of admitting an individual into their facility. This form is completed by facility personnel when accepting residents for care and support.
Form LIC 9240 is used in California by small family homes to document and track the process of admitting an individual or individuals into their home. This form is completed by small family home operators when accepting residents for care and support.
Form LIC 9239 is a general entrance checklist form used in California by group homes to document and track the process of admitting an individual into their facility. This form is completed by group home personnel when welcoming a new resident.
Form LIC 9239 YHPC is used in California by youth homelessness prevention centers to document and track the process of admitting a youth into their program. This form is completed by center personnel when providing support and services to youth at risk of homelessness.
Form LIC 9239 TrSCF is used in California by transitional shelter care facilities to document and track the process of admitting a youth into their facility. This form is completed by facility personnel when accepting a youth for temporary shelter and support during transitional periods.
Form LIC 9239 EBSH is used in California by enhanced behavioral supports homes (EBSH) to document and track the process of admitting an individual with behavioral support needs into their home. This form is completed by EBSH personnel when accepting an individual for residential care and specialized behavioral support.
Form LIC 9239 CTF is used in California by community treatment facilities to document and track the process of admitting an individual into their program. This form is completed by facility personnel when accepting an individual for community-based treatment and support.
